Telephonic Nurse Case Manager I

Elevance Health•Atlanta, GA

9d•Remote

About The Position

The Telephonic Nurse Case Manager I is responsible for telephonic care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum.

Requirements

Requires a BA/BS in a health-related field.
3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
Current, unrestricted RN license from the State of Georgia required.
Multistate licensure is required if this individual is providing services in multiple states.

Nice To Haves

Ability to talk and type at the same time.
Certification as a Case Manager.
Demonstrate critical thinking skills when interacting with members.
Experience with (Microsoft Office) and/or ability to learn new computer programs/systems/software quickly.
Ability to manage, review and respond to emails/instant messages in a timely fashion.

Responsibilities

Ensures member access to services appropriate to their health needs.
Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.
Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements.
Coordinates internal and external resources to meet identified needs.
Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
Interfaces with Medical Directors and Physician Advisor's on the development of care management treatment plans.
Assists in problem solving with providers, claims or service issues.
Assists with development of utilization/care management policies and procedures.